Abstract
Medical Ethics advisory boards are globally distributed but influenced by different traditions. In Germany this tradition follows on the one hand the ethical reflections of the medical profession and the great physician philosophers like Karl Jaspers. On the other hand, it is fundamentally shaped by the reaction to the moral catastrophes of medical research in the Third Reich. In this article, the special way of the German advisory boards is discussed. Special emphasis is laid on the role of philosophers in the proceedings. Philosophical methods in ethics are to a different degree appropriate to this role. Recent problems derive from the political tendency in Europe to harmonize procedures of the ethical advisory boards for clinical research. It is argued that medical ethics in the boards have to maintain their Socratic character instead of becoming administrative procedures.
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Notes
- 1.
On Virchow, Jaspers, and V. v. Weizsäcker, see the concise portraits collected in von Engelhardt & Hartmann, 1991.
- 2.
The German term Ethik-Kommission is often used indiscriminately for different types of advisory bodies. Its narrow sense refers to ethical advisory boards which today are charged with providing legally obligatory ethical guidance for proposed research projects in (usually clinical) research. Other panels are instituted for resolving moral conflicts that arise in therapeutic settings. They are called Ethik-Komitees, or, as we could translate, clinical ethics committees. Further advisory bodies, Ethik-Räte, or ethical councils, are convoked by legislators to support the development of general guidelines, directives, policies, and proposals for legal change (de lege ferenda); see below in Sect. 10.2.
- 3.
According to the 2005 revision of the law on pharmaceuticals (‘Bekanntmachung,’ 2005, p. 3427) clinical testing of new pharmaceuticals requires that an Ethical Advisory Board has given an antecedent approving evaluation (zustimmend bewertet, § 40).
- 4.
- 5.
Cf. on terminology above note 2.
- 6.
See, e.g., Amman, 2011.
- 7.
Such worries are appropriate wherever membership in such advisory bodies remains limited to particular corporate players, and when their authority is not backed by institutions and their representatives with democratically legitimized membership of their own. Such dangers exist, for example, wherever members of the medical profession or researchers are charged with ethically supervising those of their own group, or else when political bodies implement particular party interests through their choice of members in such panels.
- 8.
See on this issue Siep, 2008a.
- 9.
The most important confusions concerned the various voluntary versus legally obligatory engagements of such advisory bodies as well as the focus of their advice.
- 10.
On the stringent limits imposed on deliberation in this advisory body by the law itself, see a critical response by Birnbacher, 2008, especially pp. 445–447. Still closer study of the protocols of the discussions reveals that this panel enjoyed considerable freedom. It explores not only issues of scientific relevance related to specific research projects (as distinguished from issues of expected economic benefits), but also possible alternatives to the use of human stem cells, as for example fetal stem cells. Debates also turn on opportunities and risks involved in combining human and animal cell material (see the yearly reports which the Bundesgesundheitsblatt has been publishing since 2003, as well as the relevant articles in Bundesgesundheitsblatt 51/9, 2008).
- 11.
See in particular Siep, 2013.
- 12.
- 13.
Cf. also Vieth & Quante, 2001.
- 14.
- 15.
For a discourse ethical model for ethical committees, see Kettner, 2005.
- 16.
On the relevance of institutional contexts for ethical analysis, see, e.g., Nida-Rümelin, 2005. This is why ethical judgments in interdisciplinary settings cannot be reduced to a pure situation-ethical flexibility. At issue are always matters of how to apply the law to those who act as bearers of social roles, in particular physicians.
- 17.
In particular, internalist positions are distinguished by their openness for the need to negotiate moral diversity, to balance opposing views, and to work at acceptable compromises. (For a recent account of the role of compromises in ethics, see Zanetti, 2011.)
- 18.
- 19.
Cf. Albers, 2003, p. 429. This essay also offers the following quotation.
- 20.
For a discussion of the German stem cell law, see also the presentations of a colloquium on the “Competence network on stem cells” of the German Federal State Nordrhein-Westfalen, published in Honnefelder & Streffer, 2003, pp. 271–378, as well as the discussion about research with human embryonic stem cells in Siep, 2008b.
- 21.
This observation reflects the situation the author observed when this essay was first drafted in 2004. The observed reserve has been overcome in the years since then.
- 22.
The added protocol to the Convention on Human Rights and Biomedicine (Council of Europe, 2005) is meant to regulate the application of its principles to medical research. The same task of evaluating scientific validity is imposed on ethical advisory boards by the 12th novella of the ‘Arzneimittelgesetz’ (the medicinal product law, cf. ‘Zwölftes Gesetz,’ 2004). In the same vein, the stem cell law (cf. ‘Gesetz zur Sicherstellung,’ 2002) requires the Federal Advisory Board to assess the scientific salience of proposals for research with embryonic stem cells (cf. also the contributions to Siep, 2008b).
- 23.
Taupitz, in his commentary, makes clear that the term “ethical” is too narrow anyway, because unavoidably a legal assessment also belongs to the tasks of an Ethical Advisory Board (cf. Taupitz, 2002, p. 89).
- 24.
- 25.
On the contemporary relevance of this ancient ‘neighborhood’ between doctors’ ethos and philosophical ethics, see Vieth, 2004.
- 26.
On the significance of value change for philosophical ethics, see Siep, 2004, pp. 160 ff.
- 27.
Compare here Toellner, 1990, p. 12.
- 28.
On the difference between rival knowledge that can be used for profit within the framework of economic competition, and non-rival knowledge, the publication of which is required for reasons relating to the ethics of science itself, see Mohr, 1999, pp. 24 f.
- 29.
The European Parliament and the Council of the European Union (16th April, 2014).
- 30.
On the problems of how to integrate the legal and administrative salience of national ethical advisory boards, as these reflect different cultures of what may count as a violation of human dignity within Europe’s diverse member states, as well as different levels of concern in view of using those unable to consent in medical research, into the wider European context, see Vöneky, 2010.
- 31.
This tendency began with the 12th novella of the pharmaceutics law (‘Zwölftes Gesetz,’ 2004). The final version of this paper was submitted November 2014.
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Siep, L. (2022). Philosophy and Ethical Advisory Boards in German Medicine. In: Delkeskamp-Hayes, C. (eds) From Physicians’ Professional Ethos towards Medical Ethics and Bioethics . Philosophy and Medicine, vol 140. Springer, Cham. https://doi.org/10.1007/978-3-030-78036-4_10
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